Questions

Answers to Common Health Questions

Will a person with Type 2 diabetes under control end up with the need for insulin?

A: As you may have read, Type 2 diabetes is a progressive disease. Will you require insulin? That all depends on individual factors that includes, among many other factors, weight, exercise, genetics, hormones and beta-cells, those cells that produce insulin in your pancreas. Research shows that managing your diabetes early in the disease process can have big payoffs in later years. Joining a support group for people with diabetes can be helpful in keeping you going in your health quest. Following up with your health care team regularly and keeping abreast on the new developments in diabetes management can also benefit you.

Do calories from hard liquor add just as much caloric energy/fat as calories from other sources? What are "empty calories" so many people refer to?

A: Excellent question. To make a long story short: A serving of alcohol is typically not very high in calories, BUT it is metabolized very differently than our food (90 percent in the liver), which can make weight loss tricky. For example, a light beer is roughly 100 calories and so is a handful of nuts. In terms of calories, this is not much at all, but in terms of metabolism, they vary significantly, partly because you have fiber, protein, and fat in the nut and virtually none of these in beer.

This is why we can't say a calorie equals a calorie. Think of it this way, an empty calorie food or drink is something you can remove from the diet but still maintain optimal physiological function. Do our bodies need alcohol to survive? No. Candy? No. Soda? No. These are empty calories because they don't have a purpose. Do we need lean protein to survive? Yes. Fresh produce? Yes. You get the idea...

A: The scientific evidence on the role of diet in autoimmune diseases such as lupus is just becoming available. I am a believer that a plant-based diet is helpful in promoting overall health and decreasing the chemicals that cause inflammation. I advocate a plant-based diet along with a very low-fat diet. You have to recall that French fries are vegan but they are not exactly healthy. I think that exercise and healthy diet are extremely important for everyone, but more so for those with autoimmune diseases.

Answered by Howard_Smith,_MD: Dr. Smith is a rheumatologist in the Department of Rheumatic and Immunological Diseases specializing in lupus, arthritis and general rheumatology.

Is there a genetic factor to strokes?

A: Yes. There are genetic factors. There are some people that are born with certain genes that predispose them to stroke. One such condition would be CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy). If you are interested, I am sure you can learn more about this condition from the Web. Some people are born with genetic conditions that predispose them to clotting. This in turn may increase their stroke risk. Finally, if you have a strong family history of high blood pressure, diabetes, high cholesterol or any of the major modifiable risk factors for stroke, you may also be at higher risk because of this. However, these particular conditions are very much treatable and you certainly can do something about them to lower your risk.

Answered by Efrain Salgado, MD:Dr. Salgado is Director of the Cleveland Clinic Florida Stroke Center and Neurosonology Laboratory and Director of the Neurology Residency Training Program at Cleveland Clinic Florida.

What medications are best for the treatment of asthma? What are their side effects?

A: Albuterol is usually the primary "rescue" or short-term medicine that is used to help acute asthma symptoms, such as coughing or wheezing. When a patient needs to use albuterol to relieve daytime symptoms more than twice per week, however, it usually reflects the need to use daily "controller" or anti-inflammatory medications. Many people are concerned about possible side effects of inhaled steroids, which are the largest group of "controller" medications available. When used in low- to medium-doses, however, inhaled steroids are very safe, even used on a daily basis for years. They are much safer than either multiple courses of oral steroids OR uncontrolled/undertreated asthma symptoms.

Answered by John Carl, MD. Dr. Carl is a pediatric pulmonologist at Cleveland Clinic Children's who diagnoses and treats pneumonia, asthma, bronchitis, emphysema, and other respiratory problems in infants, children, and adolescents.

What exactly is a spine block injection? Will it work long-term for low back pain due to disc problems?

A: There are number of injections, and they basically are used to block the pain generators that are believed to be the cause of pain. These have been used for decades for pain control. Some need only one injection and some may need more than one to get adequate relief. There is no permanent solution that is consistent for these pain generators.

Answered by Santhosh Thomas, DO. Dr. Thomas is board-certified in physical medicine and rehabilitation. His specialty interests include electromyography, evaluation and management of back and neck pain, interventional pain management, and sports medicine.

Can you recommend any tools that will help me stay motivated to stay on my eating plan?

A: These are a few that I have found quite helpful for my patients:

Continue to remind yourself of the benefits of reaching your goal. It may be looking good in those summer shorts or having more energy to keep up with your kids. Put up notes to remind yourself if necessary.

Weigh yourself weekly and give yourself a NON-FOOD reward. It doesn’t have to be expensive. It could be giving yourself a candle-lit bubble bath or a back-rub from your spouse. Get creative.

Keep graphic records of your accomplishments. Watching that line on your weight graph go down or the line on your exercise graph go up can be quite motivating!

Answered by Maxine Smith, RD, LD. Ms. Smith has more than 20 years of experience as a registered, clinical dietitian and currently works in the department of Nutrition Therapy.

Are there any long-term effects associated with taking ADHD (attention deficit hyperactivity disorder) medications? If so, what are they and what medications are implicated?

A: Many parents are concerned about the long-term effects of taking medicines. One of the best sources of information for this question is the Multimodal Treatment Study of ADHD (MTA). This study was a very large study of the treatments typically associated with ADHD, pharmacotherapy, behavioral intervention, and their combination. Evidence regarding the side effects of using stimulant treatment for ADHD shows that long-term use of medicine may decrease stature. However, in children who have continued use of medicine with generally higher doses of methylphenidate, stature differences remain relatively small. The use of stimulants to treat ADHD both in the short-term and long-term is considered safe by most of the major medical organizations, including the American Medical Association and the American Psychiatric Association.

Answered by Michael Manos, PhD. Dr. Manos is the head of the Center for Pediatric Behavioral Health at Cleveland Clinic Children’s. He is the founding clinical and program director of the pediatric and adult ADHD Center for Evaluation and Treatment.

Can numerous fibroids and an enlarged uterus cause bladder prolapse? Why does my gynecologist think my bladder bulging into my vaginal canal is a fibroid even after I was sent to a urologist for stress incontinence issues?

A: Typically, uterine fibroids would not cause bladder prolapse. However, they can certainly make the symptoms and/or the degree of prolapse worse, depending upon the size and location of the fibroid. It is also possible that a fibroid in the right location could actually cause the front wall of the vagina—where the bladder is—to protrude. An ob/gyn can often figure this out with a pelvic examination, but sometimes an ultrasound or MRI is needed.

Answered by Matthew D. Barber, MD, MHS. Dr. Barber is Professor of Surgery at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University and Vice-Chair of Clinical Research in the Ob/Gyn and Women's Health Institute.

My son is entering middle school in the fall. What advice can I give him if he finds himself on the receiving end of cyberbullying?

A: It is great that you're already thinking about what to do before he is even entering school. Parent and child discussions are key. Make sure he is comfortable in coming to you or a trusted adult, such as a teacher, if he is being bullied or feels threatened. Before he is permitted access to social media sites, such as Twitter or Facebook, know how to block inappropriate messages and behavior. You should know how to access blocking capabilities and have access to controls on his cell phone. If he does receive a threatening message, be sure he does not respond.

Answered by Cheryl Cairns, CPNP. Ms. Cairns has been a registered nurse for more than 23 years and a pediatric nurse practitioner for 11 years. She provides preventive and chronic care, as well as urgent ill visits for children at Cleveland Clinic Children’s Hospital Community Pediatrics, Willoughby Hills.

Which is better for covering up during a sunny day, light or dark clothes? Also, is there a danger from tanning sprays rather than tanning beds?

A: Light color clothing makes you feel cooler because it reflects most of the sun rays. However, dark colors actually absorb the sun rays and helps to prevent the ultraviolet (UV) radiation from getting to the skin underneath the clothing. Therefore, dark-colored clothes are more protective against the sun than light-colored clothing in areas that are covered, but are not protective for the skin that is not covered by the dark clothing. Sunscreen is still recommended for those uncovered areas.

In terms of spray tans, there are not known harmful side effects to the skin from them. In terms of the skin, it is safe to use spray tanning. Certainly there are many known risks of tanning beds that we would recommend avoiding them entirely.

Answered by Missale Mesfin, MD. Dr. Mesfin is a is board certified dermatologist in the Department of Dermatology in Cleveland Clinic’s Dermatology & Plastic Surgery Institute.

Is breast cancer inherited?

A: Most women who get breast cancer do not have any family history of breast cancer. Just because a family member had breast cancer does not always mean that you will get breast cancer.

We do know that there are some genes associated with a known increased risk of breast cancer. These are BRCA 1 (breast cancer 1, early onset human tumor suppressor gene) and BRCA 2 (breast cancer type 2, susceptibility protein). Only 10 percent of women with breast cancer have these inherited genes. These women usually get breast cancer at a young age and have multiple family members with breast or ovarian cancer.

Answered by Stephanie Valente, DO. Dr. Valente is a breast surgeon at Cleveland Clinic. She is a board certified general surgeon with fellowship training in surgical breast oncology and serves as the Associate Director of the Cleveland Clinic Breast Fellowship.

What causes Hashimoto's thyroiditis, and what is the best method of treatment? Can iodine help this condition?

A: Hashimoto's thyroiditis is a type of autoimmune thyroid disease in which the immune system attacks and changes the texture of the thyroid gland. Hashimoto's thyroiditis stops the gland from making enough thyroid hormones for the body to work the way it should. Therefore often people will need thyroid hormone replacement. Levothyroxine replacement (T4) is used to treat Hashimoto’s thyroiditis, although there are other formulations such as Armour thyroid (which contain both T3 and T4), which is also sometimes used.

One should avoid taking iodine in this situation. If you have evidence of underactive thyroid and are symptomatic, the treatment of choice would be thyroid hormone replacement (T4 replacement).

Answered by Mary Vouyiouklis, MD. Dr. Vouyiouklis is an endocrinologist in the Department of Endocrinology, Diabetes and Metabolism in Cleveland Clinic’s Endocrinology & Metabolism Institute. She is board certified in internal medicine - endocrinology, diabetes, and metabolism.

Hearing aids are very expensive. How often will I have to be making an investment to replace or update them?

A: The typical life of hearing aids is usually about five to seven years. When you are first fitted with hearing aids, talk with your audiologist about choosing devices that will give you ‘room to grow’ in case your hearing loss progresses. Oftentimes, programming changes can be made to your current devices to accommodate changes in your hearing loss. Reasons that you may consider new hearing aids include:

Outliving the life of the hearing aids

New technologies develop that offer better listening opportunities with new features

Progression in your hearing loss beyond the capabilities of the hearing aids

These days technology advances more quickly than hearing aids stop working. Talk with your audiologist to determine if there are features or accessories that can be added to your existing devices or if newer hearing aids would be most beneficial for you.

I am trying to eat a vegetarian diet. How can I get the protein that I need?

A: It is good that you are concerned because many people who start eating a vegetarian diet simply eliminate the meat from their diet and compromise their protein needs. Rich protein sources include lentils, legumes, nuts/seeds, soy products (such as tofu or soy meat substitutes), eggs, and dairy products. You need to be intentional about consuming these foods several times throughout the day.

Answered by Maxine Smith, RD, LD. Ms. Smith has more than 20 years of experience as a registered, clinical dietitian and currently works in the department of Nutrition Therapy.

Can drinking water with lemon prevent kidney stones? Also, I have been told not to drink city water. What is the best water to drink?

A: One-half cup of lemon juice concentrate added to drinking water over the course of the day is a preventive therapy for calcium oxalate stone formation.

As for city water, it is safe to drink but the concern is with water softened using a sodium ion exchange. Softened water should not be used for cooking, drinking, or for ice dispensers.

Answered by Carolyn Snyder, MPH, RD, LD. Ms. Snyder is an American Dietetic Association registered and Ohio licensed dietician who has worked in nephrology and urology for more than 20 years. She is currently providing her services to the Metabolic Kidney Stones Clinic for the Glickman Urological & Kidney Institute.

When pain management doesn't help, what are other alternatives for back pain due to bulged discs and arthritis?

A: I usually advise people that options are nothing (leave it alone), exercise, medications, injections, surgery, or other (non-traditional like acupuncture, tai chi, or even cognitive behavioral therapy). Most people will do well with exercises and medication if needed. Surgery is usually done for so-called radicular or sciatic pains that don't get better with exercises, medications, or time. Injections may be considered for pain not relieved with time, exercise, or medication.

Answered by Russell DeMicco, DO. Dr. DeMicco is a medical spine specialist with the Center for Spine Health. His specialty interests include the evaluation and management of back pain in adults and adolescents, non-operative spine care and musculoskeletal medicine, and interventional spine procedures.

Does day care, preschool, etc. have an effect on children developing allergies or asthma?

A: Yes, it does. Most children in day care or preschool settings experience more viral respiratory infections in the first two to three years of life than children who are at home with no siblings. If you control for genetic background and environmental triggers, however, the children who attended day care/preschool had a lower incidence of asthma later in life.

Answered by John Carl, MD. Dr. Carl is a pediatric pulmonologist at Cleveland Clinic Children's. He specializes in growth and development of the lung, airways, and respiratory function in children, and uses a variety of invasive and noninvasive diagnostic techniques on young patients.

I recently read that researchers believe certain foods might cure Alzheimer’s disease. Is this true? If so, which foods do this and how much would you have to consume to get the benefits?

A: Yes, there is research on this that is ongoing and potentially very exciting. There may be a link with inflammation and the buildup of amyloid plaque on the brain that increases the risk of Alzheimer’s disease. Diet may be a great way to help combat this. What should you eat? Plenty of fresh fruits and vegetables, 100% whole grains, extra virgin olive oil, nuts, and lean protein. As for the amount, I would say that eating three handfuls of vegetables per day and two handfuls of fruits twice a day is a great start. In addition, 1 to 2 tablespoons of extra virgin olive oil and two 3-ounce servings of fish, such as salmon, per week, would be wonderful. Good luck!

A: Greek yogurt typically has more protein than regular yogurt (about 16 gm. versus 6 gm.), but it is not necessarily more healthy. No matter what type of yogurt you choose, look for one that is fat-free or at least low-fat and that is not loaded with sugar. Plain yogurt will obviously not have added sugar; and, typically, yogurts that are 100 calories or less for a 6 oz. container will be moderate in added sugar.

Answered by Maxine Smith, RD, LD. Ms. Smith has more than 20 years of experience as a registered, clinical dietitian and currently works in the department of Nutrition Therapy.

Do childhood earaches cause hearing loss later in life?

A: Recurrent ear infections during childhood can sometimes lead to chronic hearing loss. If an infection is suspected, the child should be seen by a physician for appropriate treatment.

My mother has trouble walking, but she refuses to get a walker or cane. I worry about her. How can I convince her to get some sort of walking aid?

A: We run into this situation at least two or three times a week in clinic. Sometimes, it is best to bring the parent in so he or she can hear the message from a non-family member. In this situation, I usually "soft-sell" a rollator walker. I emphasize that this is an exercise device that allows them to walk quickly and increase their distances, otherwise the legs get weaker and weaker. Offer the older patient the option of using the rollator walker in private, not out in public. Also, emphasize that the patient does not become "dependent" on the walker. It is no different than going to the grocery store and using the cart. This strengthens the legs!

Answered by Frederick Frost, MD. Dr. Frost is board-certified in physiatry (physical medicine and rehabilitation) and spinal cord injury medicine. He specializes in falls prevention, as well as spinal cord and stroke rehabilitation. Dr. Frost is also the Chair of the Department of Physical Medicine and Rehabilitation at Cleveland Clinic.

I have been approved for a penile implant. I am looking for resources about the surgery: how the implant works, how it helps the penis lengthen from a flaccid state to fully erect. Also, how do I find how much experience a doctor has in this area?

A: While there is a lot of information online about prostheses, please know that a lot of this information is written and produced by the manufacturers of these devices, so take everything with a grain of salt. I think the best information on the devices comes from reading the instruction pamphlet for the device. It gives you the bare-bones facts about how the device works. If you have access to PubMed or other search engines for peer-reviewed medical/scientific literature, you can find research studies detailing outcomes (risks, durability, etc.) of these devices. A urologist with experience with these devices should be able to give you good information about this as well. We have excellent data on long-term outcomes for inflatable penile prostheses, since these devices have been available for decades.

As far as your post-implant length goes, you can expect that your inflated (erect) length will be your stretched penile length. That's the length of your penis when you grasp the head and pull out on it. For most men, that's not the length they were when they were 18. There is one device on the market that expands in length (as well as girth) and may increase the length by a half-inch or so, but for the most part, I recommend that men expect to have their erection approximate to their stretched length post-op.

I would encourage you to find a doctor who places at least one of these devices per month on average. A local urologist or men's health specialist (and even some primary care doctors) often know who in the area is experienced with implants.

A: The most common non-medical treatment for headache is relaxation training. Many studies have demonstrated that relaxation training is equally as effective for treatment of migraine as medications. This training takes more time and effort than using a medication, but once learned, it is free, can be used whenever the patient wishes, and has no negative side effects.

Exercise has been shown to reduce headache risk and psychotherapy often helps patients learn to identify and manage headache-triggering emotional stress.

Answered by Steven Krause, PhD. Dr. Krause is a clinical psychologist at Cleveland Clinic. He specializes in pain management and directs IMATCH (Interdisciplinary Method for the Assessment and Treatment of Chronic Headaches), an outpatient treatment program for the rehabilitation of chronic headache patients.

I have lost 20 lbs., but I am afraid that I will gain it back like I always do. Is there anything I can do to help keep this weight off for good?

A: The National Weight Control Registry has been used to identify what factors help maintain a weight loss. The participants in the ongoing registry have lost a minimum of 30 lbs. and have maintained it for a year. Certain behaviors have been identified that are associated with weight maintenance. Some of these include: 45+ minutes of exercise most days of the week; following a low-fat, calorie-controlled plan; eating similarly to your regular eating plan on special occasions such as holidays/vacations; self-monitoring such as weighing yourself regularly; keeping a food diary; and support from others.

Answered by Maxine Smith, RD, LD. Ms. Smith has more than 20 years of experience as a registered, clinical dietitian and currently works in the department of Nutrition Therapy. Areas of special interest include weight, lipid and diabetes management and disease prevention.

How do I know if I have colon cancer?

A: The only way to definitively know if you have colon cancer is to be evaluated for it. There are many different ways of screening for colon cancer. Colonoscopy is considered the standard because it not only can detect cancer and precancerous polyps, it can also serve as a way to biopsy the abnormal tissue for diagnosis. In some cases, the doctor can completely remove the polyps before they become cancer. You should have a discussion with your physician to see if and when you should undergo a colonoscopy.

Oftentimes, colon cancer or precancerous polyps do not produce any symptoms. In other words, there is nothing that suggests they are there. That is one of the reasons colonoscopy is so important as a screening tool. Sometimes, patients will have symptoms that could be caused by colon cancer, such as a change in bowel habits (for example, new onset of constipation or need to strain, diarrhea, and/or thinning of the caliber of stools), crampy abdominal pain, or bleeding from the anus with or without bowel movements. These symptoms should be evaluated by a physician who can determine if you need a colonoscopy.

Answered by Charis Eng, MD, PhD. Dr. Eng is Department Chair of the Genomic Medicine Institute and American Cancer Society Professor at Cleveland Clinic. She is the founding director and attending clinical cancer geneticist of the Institute’s clinical component, the Center for Personalized Genetic Healthcare.

If an adolescent (or an adult) is hit hard in the head, at what point should they go to the ER instead of just going to their primary care doctor?

A: Great question. If an athlete has any worrisome signs, such as prolonged loss of consciousness or focal neurological signs, or if he or she is getting worse, is not arousable, or has weakness or numbness that persists, he or she should probably be seen in the ER.

Answered by Richard A. Figler, MD. Dr. Figler is a primary care sports medicine physician. He is board-certified in family medicine with a Certificate of Added Qualification in Sports Medicine. He is the primary care sports medicine team physician for John Carroll University and Solon High School.

Artificial insemination success rates seem very low. How can they be increased?

A: First, we have to put things in perspective. The monthly pregnancy rate in the fertile population is only about 20%. The monthly pregnancy rate with unexplained infertility is 2% to 3%. Treatment with artificial intrauterine insemination (IUI) alone is of little benefit. Combining IUI with an oral fertility drug, such as Clomid® (clomiphene) or Femara® (letrozole) yields about a 10% pregnancy rate per cycle. This is typically tried for up to six cycles, at which time we may continue the IUIs, substituting the more potent injectable fertility drugs for pregnancy rates of up to 20% per treatment cycle, ie, back to the normal baseline rate. This is usually tried up to three cycles before moving on to IVF.

Answered by Jeffrey Goldberg, MD. Dr. Goldberg is board certified in obstetrics and gynecology and subspecialty board certified in reproductive endocrinology by the American Board of Obstetrics and Gynecology. He is head of the Section of Reproductive Endocrinology and Infertility at Cleveland Clinic and the director of the Reproductive Endocrinology and Infertility fellowship program.

How many acupuncture treatments does it take to relieve stress? Is this something that needs continual treatment?

A: There is an individual response to each treatment session. Typically, I would recommend a minimum of one session per week for five to eight treatments total until you reach a therapeutic effect and start to feel better. Often, patients will feel an immediate stress relief after one treatment session. The goal of additional treatments is to make that response long-lasting.

You cannot control the external variables of stress. So, for some patients, they prefer to stick to a maintenance schedule of one session per month. Other patients will come in only during high peaks of stress and use acupuncture as a tool to help them through that high period of stress.

Answered by Jamie Starkey, LAc. Ms. Starkey, LAc, Lead Acupuncturist, has a Bachelor’s degree in biology and a Master’s Level Acupuncture from the American Institute of Alternative Medicine. She spent a clinical internship at the Guang AnMen Hospital in Beijing, China (Acupuncture and Moxibustion Outpatient Department).

My 5-year-old daughter has asthma. What is the effect of using an asthma preventer long-term? I heard that using it for years might cause bone shrinkage. Is it true?

A: There is a lot of discussion by parents and physicians about the use of daily inhaled steroids (the "preventers" that you mentioned). When used at low dose, I feel there is robust data to support that they are very safe, even if used for years. There are good long-term studies that show there is not any significant effect on achieved height or growth velocity, and no effect on things that are associated with use of oral steroids, such as diabetes, hypertension, and immune suppression. At low dose, they won't cause bone shrinkage. Most pediatric asthma specialists choose to decrease doses of any inhaled steroids used about every three to six months if they achieve good symptom control.

Answered by John Carl, MD. Dr. Carl is a pediatric pulmonologist at Cleveland Clinic Children's. He specializes in growth and development of the lung, airways, and respiratory function in children, and uses a variety of invasive and noninvasive diagnostic techniques on young patients.

Are there any vitamins or supplements to help vision?

A: The only truly scientific evidence says there are specific antioxidants and minerals that slow the progression in a large percentage of people who are at "high risk" for macular degeneration. Otherwise, all suggestions for vitamins are anecdotal. It is certainly true that vitamin deficiencies can have a negative effect on vision. So it is probably a good idea to take a regular multivitamin on a daily basis if you think you don't get full nutrition through your diet.

Answered by Richard Gans, MD. Dr. Gans is a comprehensive ophthalmologist with specialty interests in cataracts, glaucoma, and diabetes. He is also an accomplished surgeon and an assistant professor at The Lerner College of Medicine of Case Western Reserve University in Cleveland.

What is chronic sinusitis?

A: Chronic rhinosinusitis (CRS) is a poorly understood inflammatory condition affecting the sinuses. We are unsure of what exactly causes CRS. It is characterized by waxing and waning symptoms, including nasal drainage or post nasal drip, changes in smell, nasal congestion, facial pressure or pain, ear fullness, cough, and fatigue. The clinical diagnosis of CRS is usually made based on the time course of the disease (symptoms present for more than three months) plus some combination of signs and symptoms, CT scan results, and an endoscopic nasal examination.

Answered by Raj Sindwani, MD. Dr. Sindwani is a rhinologist who specializes in endoscopic sinus, orbital, and skull base surgery. He heads the Section of Rhinology, Sinus, and Skull Base Surgery at Cleveland Clinic.

How soon after surgery for epilepsy can a woman have a baby?

A: There are no set recommendations on when a woman would be able to conceive and have a baby after epilepsy surgery. In general, we would like to make sure that the surgery was able to control seizures (for this reason, we like to wait 6 to12 months after surgery), minimize the number of medications that the woman is taking (we prefer that no more than one medication is given), and that there have been no other surgical complications.

Answered by Imad Michel Najm, MD. Dr. Najm is the director of Cleveland Clinic's Epilepsy Center. He has been with Cleveland Clinic since 1992 in the Department of Neurology, where he leads a multidisciplinary team in the Epilepsy Center with a comprehensive range of skills and knowledge.

Do afternoon naps for one hour or so help or disturb sleep later on at night?

A: There are two processes in the brain that create sleep drive in general. The first is the body's clock. It creates sleepiness between 3 a.m. and 5 a.m. and a little bit also in the afternoon; and it paradoxically creates wakefulness at around 8 p.m., during a time called 'the forbidden zone of sleep.'

The second process relates more directly to your question. It is called “Process S,” where the “S” stands for 'sleep.' This is a process where the longer you stay awake, the more likely you are to go to the deeper stages of sleep when you go to sleep. We think it is driven by the build-up of adenosine in the brain over time. Caffeine antagonizes adenosine.

Now, if you take a nap, the brain gets rid of adenosine at its site of action rather quickly. So, if you take a nap, you are indeed less likely to be able to go to sleep as successfully at bedtime. However, this isn't the only thing driving you to sleep when you go to bed at night. We ask our insomnia patients not to nap because we want to keep as much of Process S going as we can. But we also have to think about the clock aspects of sleep. Both are involved in whether a person sleeps at a particular time.

Answered by Douglas Moul, MD. Dr. Moul is certified in both general psychiatry and sleep medicine. Among his special interests are insomnia, sleep psychiatry, and sleep disorders.

What does pelvic floor rehab therapy involve? Does it help with painful intercourse?

A: Pelvic floor rehab is an exciting, relatively new field. It is used for a variety of conditions and has been particularly helpful for situations involving pelvic pain and painful intercourse.

Typically, the pelvic floor therapist will place (painless) monitoring electrodes on different muscle groups of the vagina, demonstrate to the woman the various muscle group contractions, and help her learn how to exercise those groups of muscle. These exercises can increase or decrease muscle tone, depending on what is needed. Many women experience good results with these programs.

Answered by Margery Gass, MD. Dr. Gass is a consultant physician at Cleveland Clinic's Center for Specialized Women’s Health and is board certified in Obstetrics & Gynecology. In 2010, she became the executive director of The North American Menopause Society.

How do you determine whether your pain is back pain or actually a bad hip?

A: The symptoms of hip arthritis can superficially resemble spinal pain or sciatica. Hip joint pain is typically felt in the buttock, groin, or even in the front of the thigh descending to the knee. A careful physical examination by your physician can usually distinguish hip arthritis from a spinal cause. A plain X-ray of the hip is usually performed to confirm the presence of arthritis. In some persons with both spine and hip disease, an X-ray-guided hip injection is helpful to pinpoint the primary source of the pain.

Answered by Daniel Mazanec, MD. Dr. Mazanec is the associate director for Cleveland Clinic's Center for Spine Health and co-director for the Spine Medicine Fellowship Program. He is board certified in Internal Medicine, with a subspecialty in rheumatology.

I am always tired. Why is this, and what can I do to change it?

A: Getting enough sleep is not to be underestimated. Unfortunately, given our busy lives with work and family and other obligations, many of us do not get enough sleep. Fortunately, there are behavior modifications that you can make, starting tonight, that will improve your ability to get a good night's sleep and feel less tired. We call this "sleep hygiene," and it includes the following behaviors:

Trying to go to bed and wake up at the same time every night, regardless of whether it is a weekday or a weekend day

Avoiding caffeine at least after 6 pm, if not earlier

Limiting alcohol intake

Trying not to exercise at night just before sleep

Lying in bed awake: If you are in bed trying to sleep and are awake for more than 20 minutes, get up and out of bed; beds are for sleeping – not reading, eating, watching television, etc.

Answered by Elizabeth Ricanati, MD. Dr. Ricanati is a staff physician for the Department of Disease Reversal at Cleveland Clinic's Wellness Institute and is the medical director for its Lifestyle 180 Program.

I know I overeat at meals, but I can't help it. If I limit my portions, I'm hungry an hour later. How can I avoid overeating and have better control of my appetite? (I'm 5'6" and weigh more than 220 pounds.)

A: Consume more whole foods and fiber. Make sure you have low-fat protein and a small amount of olive oil at the meal. If you cannot self-regulate portions, then measure and weigh everything. Come to the table with a measuring cup and spoon.

Answered by Brenda Powell, MD. Dr. Powell is is a board certified physician in family medicine and currently practices at Cleveland Clinic's Wellness Institute. She specializes in integrative medicine, wilderness and travel medicine, and women's health.

How effectively can "appliances" be used to control snoring (i.e., nasal strips or that plastic thing that dilates nostrils to open nasal passages)?

A: The right appliance may be very helpful, but this will vary from person to person. If weakness of the nasal cartilage is a problem, for instance, nasal strips may be helpful. An evaluation by an ENT could help determine your specific sites of airway obstruction and the most appropriate treatment options.

A: High-profile implants can allow you to have more volume in a narrower width. Like implant volume, this decision is based on your anatomy. If a woman chooses a 350 cc [implant size], a high-profile implant will offer a lot of projection, but if she is too broad in the chest, the implant will not be wide enough. A skilled surgeon can guide these decisions and make sure you get the desired aesthetic result.

Is it beneficial to your health to take Coenzyme Q10? If so, what are the benefits? Are there any side effects?

A: CoQ10 is important in the production of energy by your body. However, your body makes CoQ10 naturally. Therefore, most people do not need it. If you experience significant fatigue, take a statin drug, or have heart disease, CoQ10 may be helpful. I do not know of any side effects.

My teenage girls want to use nail polish, but I have heard that many nail polishes contain formaldehyde and can cause cancer. Is it safe for my daughters to use it?

A: Formaldehyde is associated with increased cancer risk. Many nail polishes do contain formaldehyde. Individuals who work in the nail salon business may have an increased risk of cancer because of their exposure; however, it is not clear that an individual's use of nail polish will increase cancer risk. There are formaldehyde-free nail polishes.

How soon after a muscle strain or sprain can I begin exercising again?

A: For muscle sprain or strain, active exercise and stretching is typically necessary to help reduce pain and encourage healing. It is advisable to start stretching as soon as possible. For most back conditions, active exercise and stretching help reduce pain and encourage healing. A patient's back pain exercise program should be comprehensive, working the whole body with target to the back. The exercise program should include a combination of stretching, strengthening, and low-impact aerobic conditioning. Strengthening the core muscles will decrease the stress placed on the lower back. Walking definitely helps in conditioning the body.

Answered by Lokesh Ningegowda, MD. Dr. Ningegowda is an associate staff physician in the departments of Pain Management and General Anesthesiology, located on Cleveland Cleveland's main campus.

Can you get an STI from oral sex if one person has a fever blister? Also, if a person has an STI, is oral sex still OK?

A: Yes. STIs [sexually transmitted infections], including herpes, gonorrhea, chlamydia, and hepatitis may be transmitted orally during oral/anal sex. If there are blisters, ulcers, or any lesions present, you should abstain from this activity.

Answered by Linda Bradley, MD. Dr. Bradley is a gynecologist at Cleveland Clinic and is Vice Chair of its Ob/Gyn & Women's Health Institute. She is also Director of the Fibroid and Menstrual Disorders Center and Director of Hysterscopic Services.

If you are diagnosed with “pre-diabetes,” can you eat right and exercise enough for it to go away?

A: The diagnosis of pre-diabetes is a risk factor for developing diabetes, not an absolute certainty. So, yes, diet and exercise can normalize blood sugars and reduce your future risk of developing diabetes.

Answered by Kathryn Teng, MD. Dr. Teng is an Associate Staff Physician in Cleveland Clinic's Department of Internal Medicine. Her specialties are diabetes, high cholesterol, and hypertension.

Is there an increased risk of migraine for women who choose to take estrogen for menopausal symptoms?

A. Yes, possibly. Women with a history of migraine who take estrogen (i.e. birth control pills or hormone therapy) may experience a worsening of their migraine. Headache can be one of the more common side effects from estrogen containing medications.

A. Unfortunately, exercise does not prolong the need for knee replacement surgery. Regular exercise, however, does play a very important role in the management of arthritis. Because part of the arthritic process involves the formation of bone spurs and subsequent loss of motion, exercise is imperative to maintaining joint range of motion. Joint replacement surgery can reliably relieve pain, but it cannot reliably restore range of motion. The mantra is that the best determinant of post-operative range of motion is pre-operative range of motion.

Is it normal for young children to stop taking or needing naps? My 3½-year-old hasn’t taken a nap in quite a while, but seems to do OK.

A. We often read many books as parents, and we hope that our children fall into the molds that are described. This rarely happens. All biological phenomena (normal height, normal weight, normal blood pressure, etc.) are best described as ranges of normal rather that any one particular number.

There are many normal people who are short sleepers, just as there are some people who are long sleepers. We recognize them, just as you do your child, by the fact that they seem to behave normally when they get their quota of sleep. I would not consider your child abnormal and would also let you know that there are some first graders who still need a nap.